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Number of System-Affiliated vs Independent Community Hospitals, 1999-2015

System-affiliated hospitals outnumber those that remain independent. In 2015, 66% of community [acute care, non-federal] hospitals were affiliated with a health care system. This compares to 51% in 1999. Conversely, 34% of community hospitals were independent facilities in 2015, down from 49% in 1999.system-vs-nonsystem-comm-hosp-fy15



Fast facts on US hospitals: pie charts. American Hospital Association, Jan. 2017. http://www.aha.org/research/rc/stat-studies/Pie-charts2017.shtml

Table 2.1: Number of community hospitals, 1991-2014. In: Trendwatch Chartbook 2016, American Hospital Association, May 12, 2016. http://www.aha.org/research/reports/tw/chartbook/2016/table2-1.pdf. Related chart 2.4: Number of hospitals in health systems, 2004-2014: http://www.aha.org/research/reports/tw/chartbook/2016/chart2-4.pdf

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

RESEARCH: Takes 17 years to translate to clinical practice

This is a brief interview with Andrew B. Bindman, M.D., the director of the federal Agency for Healthcare Research and Quality (AHRQ) about recent threats to the agency’s federal funding and program priorities.  Dr. Bindman mentions that one priority is to shorten the lag time that it takes for research evidence to be disseminated into use in clinical practice.  One approach is a program called EvidenceNOW that provides coaching to primary care physicians in small practices.  Another uses telemedicine and a hub-and-spoke approach to connect specialists and PCPs.  Dr. Bindman also mentions a new Comparative Health System Performance initiative intended to compare the organizational performance of multi-institutional health systems.

Source: Stephenson, J. (2016, Sept. 30). AHRQ director sets course for agency’s health services research. JAMA.  Click here: http://jama.jamanetwork.com/article.aspx?articleid=2565313   Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

OBAMACARE: President Barack Obama and others report on health reform progress and future

If you are working up a presentation on the current and near term future of the health care system in the United States, take a look at this great source material.

President Barack Obama, writing a special communication in the first person, summarizes the effect of the first years of his landmark health reform legislation, the Affordable Care Act, popularly known as Obamacare.  Issued online July 11, the communication will also be published more formally in JAMA, the Journal of the American Medical Association, an influential journal intended for medical professionals but widely read in policy and academic circles as well.

The president opens by describing what it was like when he took office – the challenges of working through the Great Recession.  He discusses progress, noting that there has been a decline in the rate of insured Americans – from 16 percent in 2010 to 9.1 percent in 2015 – a 43 percent decrease.  He reviews how the health care delivery system has been changed, with movement toward alternative payment models.  Mr. Obama closes not only by expressing his sense of pride in the accomplishments to date but also by indicating how to build on progress and take the next steps.

WAIT, WAIT, there’s more!  This July 11 “online first” communication also includes related editorials by other eminent individuals.  Look below for more specifics on these sources.


Obama, B. (2016, July 11). United States health care reform: Progress to date and next steps. JAMA. Click here: http://jama.jamanetwork.com/article.aspx?articleid=2533698

Bauchner, H. [editor in chief, JAMA] (2016, July 11). The Affordable Care Act and the future of US health care. JAMA. Click here: http://jama.jamanetwork.com/article.aspx?articleid=2533694

Orszag, P.R. [Lazard] (2016, July 11). US health care reform: Cost containment and improvement in quality. JAMA.  Click here: http://jama.jamanetwork.com/article.aspx?articleid=2533695

Butler, S.M. [Brookings] (2016, July 11). The future of the Affordable Care Act: Reassessment and revision. JAMA.  Click here: http://jama.jamanetwork.com/article.aspx?articleid=2533696

Skinner, J. [Dartmouth], and Chandra, A. [Harvard] (2016, July 11). The past and future of the Affordable Care Act. JAMA.  Click here: http://jama.jamanetwork.com/article.aspx?articleid=2533697

Posted by AHA Resource Center (312) 422-2050, rc@aha.org



Characteristics of Hospitals Affiliated with Centralized Systems

More than half of the nation’s community hospitals are part of a multi-hospital health system. Some systems provide integrated care through centralized management, while other systems are more decentralized with hospitals unified primarily through a shared owner.

Do centralized services and increased communication affect cost and quality of care? Some literature suggests that’s the case. As a first step toward potentially gathering more data on the topic, Healthcare Cost and Utilization Project [HCUP] researchers explored the characteristics of hospitals in centralized health systems [those with centralized physician arrangements and insurance product development] compared to independent hospitals that were not part of a system. Hospitals affiliated with decentralized systems were excluded from the study.

Here are some of the findings:

  • Centralized system hospitals were more likely to be larger, urban, not-for-profit, and teaching facilities when compared to independent hospitals.
  • The South had the highest proportion of system affiliated hospitals (62%), but only 8% of its hospitals were in a centralized system.
  • The Northeast had the greatest ratio of independent hospitals (54%) but also the largest percentage of hospitals in a centralized system (11%).
  • Only small differences in payer mix were found between the two groups, although Medicaid as an expected source of payment for inpatient stays was about 5% higher in independent hospitals.
  • Patient severity of illness and mortality risk were greater for stays at centralized system hospitals.
  • Mean costs per inpatient stay were comparable for centralized system and for independent hospitals.

The researchers caution that these centralized system and independent hospitals  may differ in other ways, so inferences cannot be made from these metrics.

Source: Moore B and others. Characteristics and quality of inpatient stays at hospitals affiliated with health systems, 2009-2012. HCUP Statistical Brief [Agency for Healthcare Research and Quality], no. 197, Dec. 2015. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb197-Characteristics-Quality-Hospitals-Health-Systems.pdf

Posted by AHA Resource Center (312) 422-2050 rc@aha.org

AHA & AMA Develop Principles for Integrated Hospital-Physician Leadership

The American Hospital Association and the American Medical Association have jointly published principles for success in integrating physician/clinician and hospital/system leadership. Both organizations worked together on the guidelines for over two years to address the changing hospital and physician relationships.

While there can be different leadership structures within organizations, they should involve theses core principles:

  • Physician and hospital leaders with similar values and expectations; aligned incentives and goals with appropriate metrics; shared responsibility for meeting financial and quality targets; accountable service line teams; shared strategic planning and management; and shared focus on patient engagement as partners in their care.
  • Interdisciplinary structure that supports collaborative decision-making, while preserving clinical autonomy for physicians.
  • Integrated clinical and hospital leadership, including nurses and other clinicians as well as physicians, present at all levels of the system with participation in all key management decisions and accountability to and for each other on the team.
  • Collaborative, participatory partnership built on trust.
  • Open and transparent sharing of clinical and business information across the continuum by all parties.
  • Clinical information system infrastructure for capturing and reporting performance metrics for all participants and system-wide accountability for those measures.

The report further fleshes out the principles in the context of physician organization, leadership development, and cultural adaptations. It also identifies and briefly explains potential challenges.

Source: Integrated leadership for hospitals and health systems: principles for success. American Hospital Association; American Medical Association, June 2015. http://www.aha.org/content/15/ahaamaintegrleadership.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Update: Number of System-Affiliated vs Independent Community Hospitals, 1999-2013

The proportion community hospitals that were system-affiliated grew to 63.2% in 2013 [3,144 of 4,974 total hospitals], while on the flip side, independent hospitals now represent 36.8%. This compares to 53.6% of community hospitals that were system-affiliated in 2003. The trend is charted below:

Chart 2.4 System hosp trends


Chart 2.4: Number of hospitals in health systems, 2003-2013. In: AHA Trendwatch Chartbook. American Hospital Association, Feb. 19, 2015.  http://www.aha.org/research/reports/tw/chartbook/2015/chart2-4.pdf

Table 2.4: Data for Chart 2.6. In: AHA Trendwatch Chartbook. American Hospital Association, Feb. 19, 2015. http://www.aha.org/research/reports/tw/chartbook/2015/table2-1.pdf

Related source: Chart 2.9: Announced hospital mergers and acquisitions, 1998-2013 In: AHA Trendwatch Chartbook. American Hospital Association, 2014. http://www.aha.org/research/reports/tw/chartbook/2014/chart2-9.pdf

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org


Physician Employment Trends in Health Systems

Trends in physician employment by health systems are illustrated by SK&A in 2 comparative maps — one for November 2011 and another for March 2014 — showing the changes in physician employment rates state by state over the past 3 years.

Generally, the upper midwest and New England regions of the country have the highest physician employment rates for health systems. Employment rates for 2014 ranged from 22% in Nevada to 73% in North Dakota.

Source: Physician employment trends in health systems. SK&A, March 2014. http://www.skainfo.com/integrated_health_systems/Physician_Employment_Map.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Top 25 Integrated Health Systems – 2014

See 2015 update.

SK&A has updated its annual ranking of the largest 25 integrated health systems based on the total number of affiliated health facilities. Topping the list are Ascension Health, VA [Veterans Affairs] Health Systems, and Community Health System Inc. However, Kaiser Permanente has the most affiliated physicians, while HCA Inc. includes the most hospitals.

For each system listed, the headquarters state location is given along with the count of associated hospitals, medical offices/groups, nursing homes, physicians, and total facilities.

Source: Top 25 integrated health systems – SK&A market insight report. SK&A, 2014. http://www.skainfo.com/registration_OneKey.php [free registration required to view/download the report]

Related link: Top 25 integrated health systems – 2013

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ACADEMIC MEDICAL CENTERS: Org charts and the future of AMCs

It is always exciting to find examples of organization charts, which explains why I led off with that fact in the title of this post.  They can be found in the second document cited below–the Profiles–which takes a look at 13 leading academic medical centers in the United States.  But these two reports are so much more than a place to find a few org charts.  They represent the report of a panel charged with taking a careful, comprehensive look at the direction that academic health centers  need to go in the near future to ensure viability in a changing health care system.  And “SYSTEM” is a key–take a look at the first theme cited:

  • “The AMC of the future will be system-based, with a broad regional presence and clinical services aligned across the continuum of care.”
  • Five options thatAMCs might use to achieve move toward achievement of this first theme are:
    • “Merge/affiliate with mega-system”
    • “Specialized complex care leader”
    • “High performance regional system”
    • “Public entity statewide hub”
    • “Population health manager”

There are seven more themes developed in the report.  At the end of the report are a series of questions related to each theme that can be used by AMC leaders to start a discussion, and also a self-assessment tool.

Sources: Enders, T., and Conroy, J.  Advancing the Academic Health System for the Future: A Report from the AAMC Advisory Panel on Health Care.  Washington, D.C.: Association of American Medical Colleges, 2014.  Click here for access to this report: https://www.aamc.org/initiatives/patientcare/aphc/357864/academichealthsystem.html; and, Advisory Panel for Health Care: Advancing the Academic Health System for the Future: Profiles in Academic System Leadership.  Washington, DC: Association of American Medical Colleges, Nov. 2013.  Click here for access to this report: https://www.aamc.org/initiatives/patientcare/aphc/359476/profiledinstitutions.html  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

National Profiles of Health Care Systems in 14 Countries

How does the U.S. health system compare to those in other countries? The Commonwealth Fund has published comparative profiles of the national health care systems in each of these countries:

  1. Australia
  2. Canada
  3. Denmark
  4. England
  5. France
  6. Germany
  7. Italy
  8. Japan
  9. Netherlands
  10. New Zealand
  11. Norway
  12. Sweden
  13. Switzerland
  14. United States

Each national profile covers these health system aspects:

  • Health insurance
  • Public and private financing
  • Health system organization and governance
  • Health care quality and coordination, disparities, efficiency, and integration
  • Use of information technology and evidence-based practice
  • Cost containment
  • Recent reforms and innovations

Summary tables are also available for quick comparisons among countries on health system characteristics and performance indicators.

Source: Thomson S and others, London School of Economics and Political Science. International profiles of health care systems, 2013. The Commonwealth Fund, Nov. 2013. http://www.commonwealthfund.org/~/media/files/publications/fund-report/2013/nov/1717_thomson_intl_profiles_hlt_care_sys_2013_v2.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org